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Key Slides. Involving patients in treatment decisions. Shared decision-making. ‘a decision making process jointly shared by patients and their healthcare provider’ Legare F, et al. Cochrane Database Syst Rev 2008;(3) 2.

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Involving patients in treatment decisions

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shared decision making
Shared decision-making

‘a decision making process jointly shared by patients and their healthcare provider’

Legare F, et al. Cochrane Database Syst Rev 2008;(3)


factors affecting a consultation
Factors affecting a consultation
  • Healthcare



- Previous consultations

- Problem under discussion

  • Consultation skills
  • Trust

Makoul G, et al. Patient Educ Couns 2006; 60(3): 301-312.


open ended questions
Open-ended questions
  • Invite an extended response from the patient
  • Cannot usually be answered by a yes/no response
  • Do not assume a particular response from the patient
    • ‘Tell me some more about that’
    • ‘How do you feel about…’
    • ‘Describe what it’s like when…’


patient preferences about treatment decisions
Patient preferences about treatment decisions

Cox K, et al, Br J Gen Pract 2007; 57(543):777-784


patient misconceptions about medicines
Patient misconceptions about medicines
  • Effects of medicine or disease?
  • Information sources e.g. internet, other people
  • Fear of dependency and tolerance
  • Health beliefs

Pound P, et al. Soc Sci Med 2005; 61(1):133-155


mental capacity
A patient must not be assumed to lack capacity to make a decision solely because of:





Medical condition (including mental illness)

Their beliefs

Apparent inability to communicate

Making a decision that a healthcare professional disagrees with

Mental capacity

World Health Organization (WHO) . Adherence to long-term therapies;

evidence for action. 2003.


NICE Clinical Guideline CG76 Medicines Adherence: involving patients in decisions about prescribed medicines and supporting adherence P57
acceptors and resistors

‘Passive’ coerced into taking e.g.

care settings

‘Active’ may modify regimes to

Minimise side effects

Make regimen more acceptable


Worries about dependence

Long-term harm

Masking of symptoms

‘Acceptors’ and ‘Resistors


ways patients take medicines
Ways patients take medicines

Patients wish to minimise their intake of medicines:

  • To decrease adverse effects and dependence
  • To make the regimen more acceptable
  • Financial reasons
  • According to symptoms
  • Using them strategically
  • Non-pharmacological treatments


discussing minimising medicines
What will happen if they don’t take the medicine

Non-pharmacological alternatives

Reducing or stopping long-term medicines

Fitting medicines into their routine

Choosing between medicines

Discussing minimising medicines


what do patients want to know
What do patients want to know?


What does it do?

How to take it?

Dos and don’ts


inform the patient about
Inform the patient about…
  • The medicine
    • What it is
    • How to use it
    • Likely benefits
  • Adverse effects
    • What to do if you experience them
  • Missed doses
    • What to do
  • Further prescriptions
    • How to get them